Minimal-Stimulation IVF
At the Continuum Reproductive Center

The Continuum Reproductive Center is among a limited number of fertility practices now offering minimal-stimulation in vitro fertilization (MS-IVF). MS-IVF is a less invasive IVF protocol than conventional IVF and is an appropriate alternative for certain patient groups. The Continuum Reproductive Center’s medical and scientific team is highly respected in the field of reproductive medicine, and has expertise and many years of experience in all aspects and types of IVF.

How does minimal-stimulation IVF differ from conventional IVF?

IVF involves a series of steps:

Step 1: Stimulation of the ovaries with medications to allow multiple eggs to develop

Step 2: Retrieval of the eggs from the ovaries (“egg retrieval” or “harvesting”)

Step 3: Fertilization of the eggs with sperm and culturing of the embryos in incubators

Step 4: Transferring one or more embryos to the uterus

Both conventional and minimal-stimulation IVF are essentially identical in steps 2, 3 and 4. The protocols differ in Step 1, ovarian stimulation. In conventional IVF, varying doses of hormones are injected daily for several days in order to yield multiple follicles and eggs. In MS-IVF, physicians use oral medications or a mixture of oral medications and low doses of injectable hormones.

Why do different practices and IVF centers use conventional IVF protocols and others MS-IVF?

Practices and physicians have varying philosophies and experience with each type of protocol. Most centers in the United States use conventional IVF, while a few centers practice almost exclusively MS-IVF. The physicians of the Continuum Reproductive Center are experienced with many protocols and believe that the protocol used must be individualized to each patient’s needs. We make recommendations based on a variety of factors, including the age of the patient, the indications for IVF, and the response of the patient to ovarian stimulation medications in prior insemination and IVF cycles.

During the early years of IVF, ovarian stimulation medications were administered orally or not at all. Pregnancy rates were significantly lower than current rates for a variety of reasons, including suboptimal laboratory materials and equipment, the relative lack of expertise of physicians and embryologists, and low egg yields. The stimulation protocols used resulted in high rates of premature ovulation and frequently no eggs available at retrieval. Over time, reproductive endocrinologists began to conduct ovarian stimulation with injectable hormone medications in order to better regulate the cycles and induce development of multiple eggs. The rationale for allowing multiple eggs to develop is that many eggs are abnormal and might lead to poor pregnancy and high miscarriage rates. With multiple eggs developing, there is an increased chance that at least one will result in a normal embryo and thus enhance the chances for a successful pregnancy.

At the present time, the chances of achieving a pregnancy with conventional stimulation methods is higher than with minimal-stimulation IVF. However, the use of new medications to minimize the risk of premature ovulation has allowed the success rates from MS-IVF to improve significantly. Whether MS-IVF can yield pregnancy rates comparable to conventional IVF remains to be determined. MS-IVF does, however, have several advantages over conventional IVF and may be a reasonable and appropriate choice for selected patients and couples.

What are the advantages of MS-IVF?

Comfort and Convenience

MS-IVF involves the use of fewer medications, and lower doses of medication, than conventional IVF. Patients doing conventional IVF protocols are typically required to be monitored with blood-hormone tests and vaginal sonograms every 24 to 72 hours. These tests allow the IVF team to modify the patient’s medication dosing and time when the egg retrieval should be performed. With MS-IVF, fewer monitoring visits are required, thus reducing patients’ inconvenience and stress. In addition, patients are required to inject themselves less frequently than with conventional IVF, limiting the level of discomfort common with fertility medications.

Cost

The use of fewer medications, and lower doses of these medications, often results in a significant cost savings for patients, amounting to hundreds or thousands of dollars per cycle. As many patients do not have insurance coverage for medications, this savings can be the sole factor that determines if a patient can undergo IVF or must forego this option.

What has not yet been determined is whether the cost savings per cycle for MS-IVF translates into a cost savings per pregnancy achieved. As MS-IVF appears to result in a lower pregnancy rate per cycle than conventional IVF, more cycles of MS-IVF are required to achieve a pregnancy than with conventional IVF. Further studies are needed to adequately compare the total cost expenditures for minimal stimulation as compared to conventional IVF.

Side Effects and Risks for Ovarian Hyperstimulation Syndrome

The injectable ovarian-stimulation medications used in conventional IVF cause some patients to experience significant side effects, including bloating, fatigue, and breast tenderness. In a small percentage of patients, these medications can lead to ovarian hyperstimulation syndrome (OHSS), a condition in which the ovaries can become markedly enlarged and fluid can accumulate in the pelvis, abdomen and chest cavities. While OHSS is usually mild and quickly resolves, some patients require hospitalization for intravenous fluids and might require procedures to remove fluid from the pelvis and abdomen. Blood-thinning medications are used to prevent dangerous blood clots from forming. As compared to conventional IVF, the chances of developing OHSS with MS-IVF are greatly reduced.

Anesthesia

In MS-IVF, a patient commonly develops only one or two follicles and may be able to undergo egg retrieval with local anesthesia, avoiding the general anesthesia or intravenous sedation required for most conventional IVF patients. In these cases, patients can therefore save $400-$600 in anesthesia fees.

Ethical Concerns

Some patients and couples are ethically, religiously or morally opposed to the cryopreservation of embryos. MS-IVF generates fewer embryos than conventional IVF, in most cases making it unnecessary to consider or employ cryopreservation.

Other Possible Advantages

Some reproductive specialists believe that the high doses of ovarian-stimulation hormones used in many conventional IVF cycles might reduce the chances of fertilization, implantation and pregnancy. Data are limited and conflicting at this time. Further research is required to make conclusions regarding the superiority of one method over another in selected patient groups.

What are the disadvantages of MS-IVF?

Pregnancy Rates

Multiple studies of MS-IVF have been conducted, but few involve well-designed head-to-head comparisons of MS-IVF versus conventional IVF. At the current time, pregnancy rates reported for conventional IVF are higher than with MS-IVF and conventional IVF remains the standard therapy utilized by most IVF centers in the United States.

Lack of Embryos for Cryopreservation

One advantage of making multiple eggs in conventional IVF is the potential for multiple embryos to develop. After the transfer of a limited number of embryos, the remaining, high-quality embryos can be cryopreserved (frozen) for later use. These embryos might allow patients who do not conceive in a fresh cycle to conceive without having to undergo another cycle of injectable hormones and egg retrieval. In patients who do conceive successfully in the fresh cycle, frozen embryos can be used in the future to conceive another child.

Am I a good candidate for MS-IVF?

Additional research might elucidate which patients would benefit most from MS-IVF as compared to conventional IVF. At the Continuum Reproductive Center, most patients continue to undergo the conventional stimulation protocols. We believe, however, that appropriate candidates for MS-IVF include patients who have failed to develop multiple eggs in response to conventional ovarian stimulation, women with hypersensitive ovaries in whom conventional stimulation protocols might lead to severe OHSS, and patients with significant financial constraints for whom conventional IVF is not an option. At the Continuum Reproductive Center, patients and couples are well-counseled regarding the potential advantages and disadvantages of MS-IVF.

Patients and couples with the following characteristics are not currently offered MS-IVF at the Continuum Reproductive Center:

• Severe male factor infertility
  
• Age > 45
  
• Follicle stimulating hormone (FSH) level > 20 IU/L
  
• Recurrent miscarriages during natural conception cycles
  
• Patients undergoing IVF for elective cryopreservation of eggs or embryos
  
• IVF cycles in which pre-implantation diagnosis (PGD) of embryos is planned

If you are interested in learning more about the MS-IVF program at the Continuum Reproductive Center, please visit us at www.continuumfertility.com or contact us at:

Continuum Reproductive Center
425 West 59 Street (Suite 5A)
New York, New York 10019
Tel. (212) 523-7751
Fax. (212) 523-8348

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